Healthcare Provider Details

I. General information

NPI: 1427823798
Provider Name (Legal Business Name): SERENITY HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SOVEREIGN CT STE 209
BALLWIN MO
63011-4435
US

IV. Provider business mailing address

301 SOVEREIGN CT STE 209
BALLWIN MO
63011-4435
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-3180
  • Fax:
Mailing address:
  • Phone: 314-833-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: YOSEF MANNE
Title or Position: MEMBER
Credential:
Phone: 314-833-3180